分析D-二聚体在高危性胸痛病因诊断中的应用价值。

回顾性分析2018年1月至2020年5月在扬州大学医学院附属泰兴市人民医院急诊科并明确诊断为高危性胸痛患者120例的临床资料，其中男性75例，女性45例；年龄44～78岁，平均(62.43±5.28)岁；体重指数(18.26～24.37)kg/m²，平均(21.34±0.98)kg/m²。统计高危性胸痛中急性心肌梗死、主动脉夹层、肺栓塞的发生占比情况，测定急性心肌梗死、主动脉夹层、肺栓塞患者的D-二聚体水平，并进行比较。

120例高危性胸痛患者中，急性心肌梗死共53例(44.17%)，主动脉夹层共38例(31.67%)，肺栓塞共29例(24.16%)。肺栓塞患者血清D-二聚体水平高于主动脉夹层与急性心肌梗死，且主动脉夹层患者血清D-二聚体水平高于急性心肌梗死，差异有统计学意义(P<0.05)。

血清D-二聚体在不同病因所致的高危性胸痛中的水平表达存在明显差异，其在急性心肌梗死患者中表达较低，呈轻度升高，在肺栓塞患者中升高趋势最为显著，故临床上可通过检测高危性胸痛患者的D-二聚体水平，来鉴别诊断急性心肌梗死、主动脉夹层、肺栓塞。

To analyze the application value of D-dimer in the etiological diagnosis of high-risk chest pain.

The clinical data of 120 patients with high-risk chest pain diagnosed in our hospital from January 2018 to May 2020 were retrospectively analyzed, including 75 males and 45 females; the average age was (62.43±5.28) years, with range of 44-78 years; the body mass index (BMI) was (18.26-24.37) kg/m², with an average of (21.34±0.98) kg/m². The proportion of acute myocardial infarction, aortic dissection and pulmonary embolism in high-risk chest pain was statistically analyzed. The level of D-dimer in patients with acute myocardial infarction, aortic dissection and pulmonary embolism was measured and compared.

Among the 120 patients with high-risk chest pain, 53 cases had acute myocardial infarction, accounting for (44.17%); 38 cases had aortic dissection, accounting for (31.67%); 29 cases had pulmonary embolism, accounting for (24.16%); the serum D-dimer level in patients with pulmonary embolism was higher than that in patients with aortic dissection and acute myocardial infarction, and the level of serum D-dimer in patients with active venous dissection was higher than that in patients with acute myocardial infarction (P <0.05).

The expression of serum D-dimer in high-risk chest pain caused by different causes is significantly different. Its expression in patients with acute myocardial infarction is low, showing a slight increase, and the rising trend is the most significant in patients with pulmonary embolism. Therefore, the level of D-dimer in patients with high-risk chest pain can be detected clinically to differentiate and diagnose acute myocardial infarction, aortic dissection and pulmonary embolism.